Treatments Flashcards
(210 cards)
1
Q
Which two types of hepatitis are fecal?
A
A, E
No chronic infection
2
Q
How to prevent hep E?
A
ensure safe drinking water
3
Q
Which types of hepatitis have percutaneous/mucosal transmission?
A
B, C, D
blood/body fluids
4
Q
Which types of hepatitis are prevented with pre/post exposure immunization?
A
A, B, D
5
Q
Which type of hepatitis is prevented with blood donor screening/risk behavior modification?
A
C
6
Q
Hep A vaccine:
What is the Havrix vaccine schedule?
A
0, 6-12 months
Age 1-18: 0.5 mL
Age >=19: 1mL
7
Q
Hep A vaccine:
What is the Vaqta vaccine schedule?
A
0, 6-18 months
Age 1-18: 0.5mL
Age > 19: 1mL
8
Q
Hep A vaccine:
What is the Twinrix vaccine schedule?
A
0, 1, 6 months
Age >=18: 1mL
9
Q
Which Hep B antigen is found on surface of HBV and denotes chronic infection if present for > 6 months?
A
HBsAG
hepatitis B surface antigen
10
Q
Which hepatitis antigen is present in active infection?
A
HBeAG
hepatitis B envelope antigen
11
Q
Which antigen indicates acute hep B infection (within 6 months)?
A
IgM anti-HBc
immunoglobulin antibody to hepatitis B core antigen
12
Q
How is HBV DNA measured?
A
as visual load (IU/mL); amount of DNA per mL of plasma
13
Q
Which hep B antibody is formed in response to HBsAG, and is a predictor of long-term suppression?
A
HBeAb
hepatitis B envelope antibody
14
Q
Which hep B antibody indicates previous or ongoing infection?
A
Anti-HBc
total hepatitis B core antibody
15
Q
Which hep B antibody indicates immunity, and is produced after recovery of HBV infection of vaccination?
A
Anti-HBs
hepatitis B surface antibody
16
Q
Which hep B antigens/antibodies are positive if immune due to natural infection?
HBsAG
anti-HBc
anti-HBs
A
anti-HBc
anti-HBs
17
Q
Which hep B antigens/antibodies are positive if immune due to HBV vaccination?
HBsAG
anti-HBc
anti-HBs
A
anti-HBs
18
Q
Which hep B antigens/antibodies are positive is acutely infected?
HBsAg
anti-HBc
IgM anti-HBc
anti-HBs
A
HBsAg
anti-HBc
IgM anti-HBc
19
Q
Which hep B antigens/antibodies are positive if chronically infected?
HBsAg
anti-HBc
IgM anti-HBc
anti-HBs
A
HBsAg
anti-HBc
20
Q
Which antigens/antibodies are positive with hep B resolved infection (most common), false positive (susceptible), low level chronic infection, resolving acute infection?
HBsAg
anti-HBc
anti-HBs
A
anti-HBc
21
Q
Hep B vaccine:
What is the Engerix vaccine schedule?
A
0, 1, 6 months
all ages
22
Q
Hep B vaccine:
What is the recombivax schedule?
A
0, 1, 6 months
Ages >= 1 year
23
Q
Hep B vaccine:
What is the Heplisav-B vaccine schedule?
A
0, 1 months
Ages >= 18 years
24
Q
HBV chronic Tx:
Which is contraindicated with CrCl < 15?
A
tenofovir alafenamide
25
Tenofovir alafenamide dose for chronic HBV?
25mg QD with food
26
Tenofovir disoproxil fumarate dose for chronic HBV?
300mg QD
with CrCl > 50
can cause nephropathy
27
entecavir dose for chronic HBV?
0.5mg tab QD
1mg tab QD if lamivudine experience
28
pegylated interferon dose for chronic HBV?
180mcg SQ weekly
29
3 non-preferred HBV Tx:
- lamivudine (Epivir)
- adefovir (Hepsera)
- telbivudine (Tyzeka)
30
Which HBV Tx is recommended if finite treatment is desired?
pegylated interferone
31
Which HBV Tx should be avoided if concerns for tolerability and presence of co-morbidities?
pegylated interferone
32
Which HBV Tx should be avoided if Hs of lamivudine resistance?
entecavir
33
Which HBV Tx is recommended for family planning?
pegylated interferon pre-pregnancy
| tenofovir disoproxil fumarate
34
What is drug of choice for HBV treatment with concurrent HDV co-infection?
pegylated interferon
35
2 treatments for HBV in pts with decompensated cirrhosis?
- entecavir
- tenofovir disoproxil fumarate (TDF)
continued indefinitely
36
Is entecavir reliable for HBV Tx with HIV co-infection?
no
need 2 agents:
- tenofovir + emtricitabine/lamivudine
37
How long should HBV pts immunosuppressive/cytotoxic therapy be treated?
>= 6 months post completion of Tx
38
Hep C:
Which suffix indicates NS3/4A protease inhibitors?
-previr
39
Hep C:
Which suffix indicates NS5B inhibitors?
- buvir
40
Hep C:
Which suffix indicates NS5A inhibitors?
-asvir
41
Hep C:
sofosbuvir/ledipasvir dose?
400mg/90mg daily
42
Hep C:
Which genotypes are covered by sofosbuvir/ledipasvir?
1, 4, 5, 6
43
Hep C:
Which genotypes are covered by grazoprevir/elbasvir?
1, 4
44
Hep C:
What is grazoprevir/elbasvir dose?
100mg/50mg QD
45
Hep C:
What is sofosbuvir/velpatasvir dose?
400mg/100mg QD
46
Hep c:
What genotypes are covered by sofosbuvir/velpatasvir?
1-6
47
Hep C:
What genotypes are covered by glecaprevir/pibrentasvir?
1-6
48
Hep c:
What is the dose of glecaprevir/pibrentasvir?
100mg/40mg 3 tabs daily with food
49
Hep C:
What genotypes are covered by sofosbuvir/velpatasvir/voxilaprevir?
1-6
mainly reserved for pts with prior DAA failures
50
Hep C:
What is the dose for ribavirin?
< 75kg: 1g in 2 divided doses
> 75kg: 1.2g in 2 divided doses
TAKE WITH FOOD!
51
Hep C:
Which protease inhibitors should be avoided in pts with decompensated cirrhosis?
NS3/4A
52
What treatment is usually added for Hep C in decompensated cirrhosis?
ribavirin
or treatment extended to 24 weeks
53
Hep C:
Which genotype is the most difficult to treat in setting of prior tx and/or cirrhosis?
genotype 3
54
Hep C:
What Tx is approved for pts >=3 years old?
sofosbuvir/ledipasvir
55
Hep C:
Which Tx is approved for pts >=12 years old?
glecaprevir/pibrentasvir
56
Discontinue Hep C Tx if ALT is how high?
>=10 times the ULN
57
What lab is needed for Hep C pts on ribavirin?
CBC
58
When is HCV viral load tested post-treatment?
12 weeks post treatment
59
HIV:
HLA5701*B testing is recommended with prior to using which NRTI?
abacavir
60
Which NRTI causes renal impairment, bone demineralization, and a DECREASE in lipids?
tenofovir disoproxil fumarate (TDF)
61
Which NRTI causes weight gain and INCREASES lipids?
tenofovir alafenamide (TAF)
62
Which 2 INSTIs should be separated from cations by 2 hours before or 6 hours after?
- bictegravir
| - dolutegravir
63
FDA approval for which INSTI is expected any day now?
cabotegravir
injectable in combo with rilpivirine
64
3 NNRTIs that cause rash, elevated LFTs, and DDIs?
- doravirine
- efavirenz
- rilpivirine
65
Which NNRTI can be taken with or without food?
doravirine
66
Which NNRTI should be taken at bedtime on empty stomach?
efavirenz
67
Which NNRTI should be taken with whole glass of water and normal/high calorie meal?
rilpivirine
68
Which 2 NNRTIs should not be used if HIV viral load is > 100,000 copies?
- efavirenz
| - rilpivirine (also if CD4 < 200)
69
Which protease inhibitor is only used as a boosting agent?
ritonavir
70
4 first line therapies for MOST pts with HIV:
- tenofovir alafenamide/emtricitabine + bictegravir
- abacavir/lamivudine + dolutegravir
- tenofovir (either)/emtricitabine + dolutegravir
- tenofovir (either)/emtricitabine + raltegravir
71
What two drugs/classes should be avoided in HIV pts with high cardiac risk?
abacavir
| protease inhibitors
72
Which tenofovir lowers lipids?
disoproxil fumarate
73
Which tenofovir should be avoided in pts with kidney disease?
disoproxil fumarate
74
Which drug/class should be avoided in HIV pts with hyperlipidemia?
efavirenz
| protease inhibitors
75
Which tenofovir should be avoided in pts with osteoporosis?
disoproxil fumarate
76
What 2 NNRTIs should be avoided in pts with psychiatric illnesses?
- efavirenz
| - rilpivirine
77
What 2 NNRTIs cause QTc prolongation?
- efavirenz
| - rilpivirine
78
What tenofovir should be avoided if weight gain concerns?
alafenamide
especially in combo with an INSTI
79
Which PrEP is for all people at risk through sex or injection drug use?
tenofovir disoproxil fumarate + emtricitabine (Truvada)
80
Which PrEP is for people at risk through sex except those assigned female at birth at risk from vaginal sex?
tenofovir alafenamide + emtricitabine (Descovy)
81
PrEP:
Which PrEP has a generic available?
tenofovir disoproxil fumarate + emtricitabine
82
How long does PrEP take to be effective?
21 days
83
How often are labs performed with PrEP?
every 3 months
84
How long is PEP used?
28 days
Most effective if started ASAP within 72hours of exposure
85
What combo is used as HIV PEP?
tenofovir disoproxil fumarate + emtricitabine + dolutegravir or raltegravir
86
Opportunistic infection:
PJP pneumonia prophylaxis Tx?
SMX/TMP 1 DS PO daily
CD4 < 200
87
Opportunistic infection:
PJP pneumonia mild to moderate Tx?
SMX/TMP 5-7mg/kg PO TID x 21 days
88
Opportunistic infection:
PJP pneumonia moderate to severe Tx?
SMX/TMP 15-20mg/kg/day IV q6-8hrs x 21 days
89
opportunistic infection:
Toxoplasmosis prophylaxis?
SMX/TMP 1DS PO daily
CD4 < 100
90
opportunistic infection:
Mycobacterium avian complex (MAC) prophylaxis?
azithromycin 1200mg PO once weekly
CD4 < 50 and not on suppressive ART
91
opportunistic infection:
Mycobacterium avian complex (MAC) treatment?
clarithromycin 500mg PO BID + ethambutol 15mg/kg PO daily
12 months of therapy
92
opportunistic infection:
Toxoplasmosis treatment?
combo at least 6 weeks of induction, then maintenance
pyrimethamine, sulfadiazine, and leucovorin
93
opportunistic infection:
Immune reconstitution inflammatory syndrome (IRIS) treatment?
supportive care
94
opportunistic infection:
Immune reconstitution inflammatory syndrome (IRIS) prophylaxis?
delay ART by about 2 weeks of induction
95
Does acyclovir have activity against CMV?
no
96
Which antiviral has activity against adenovirus, CMV, HSV, and VZV?
cidofovir
ganciclovir is +/- for adenovirus
97
2 first line treatments for CMV?
- ganciclovir
| - valganciclovir
98
Which 2 CMV drugs need CBC with differential and BMP at baseline/weekly?
ganciclovir
| valganciclovir
99
What 2 drugs are IV only and used for resistant CMV?
- foscarnet
| - cidofovir
100
What resistant CMV drug must be given with fluid electrolyte replacement?
foscarnet
101
What resistant CMV drug must be given with probenecid?
cidofovir
102
Which CMV drug is for prophylaxis only?
letermovir
103
What mab works on the spike proteins of SARS COV2?
bamlanivimab
administer within 10 days of Sx onset
104
Cidofovir MOA?
selective inhibition of viral DNA synthesis
105
What 2 BBWs does foscarnet have?
- renal impairment
| - seizures
106
Which 2 CMV drugs have BBW for bone marrow suppression?
- ganciclovir
| - valganciclovir
107
Which CMV drug has MOA of inhibiting DNA terminate complex preventing proper viral DNA length and vision maturation?
letermovir
only indicated for CMV prophylaxis in bone marrow transplant recipients
108
Which CMV drug is an adenosine nucleostide prodrug that competitively inhibits RNA polymerase causing chain termination?
remdesivir
109
Which CMV drug has a BBW for hemolytic anemia?
ribavirin
take capsule WITH food
110
How is CMV transmitted?
contact with fluids
111
How is coronavirus transmitted?
droplet
airbone
fomites
GI
largely depends on strain
112
How is VZV transmitted?
direct contact
113
How is measles transmitted?
droplet
| airborne
114
How is mumps transmitted?
contact
| droplet
115
How is VZV prevented?
- immunizations
| - avoid contact for 4-5 days after lesions heal
116
Fungal infections:
What is the general MOA for flucytosine and griseofulvin?
replication/division inhibitors
117
Fungal infections:
Do echinocandins work on the cell wall or membrane?
wall
Beta-1,3-D glucan synthesis inhibitors
118
What is the general MOA for triazoles and polyenes (amphotericin B)?
cell membrane ergosterol inhibitors/binders
119
Which antifungal is DOC for blastomyces/histoplasma and coccidioides?
itraconazole
120
Which antifungal is DOC for Aspergillus?
voriconazole
121
Which azole is DOC for C. albicans if susceptible?
fluconazole
122
Which azole is DOC for dimorphic molds?
itraconazole
123
What is the dose for liposomal AmB?
3-5mg/kg IV daily
124
Which echinocandin is dose adjusted for Child-Pugh class?
caspofungin
125
Micafungin dose?
100mg IV q24h
126
Which triazole is IV:PO 1 to 1 ratio and prolongs QTc?
fluconazole
127
Which 3 triazoles need TDM?
- itraconazole
- voriconazole
- posaconazole
all triazoles need LFTs weekly and BMP every 2-3 days
128
Which triazole needs visual exam if used > 28 days?
voriconazole
129
Which triazole has capsules taken with food, solution taken without food?
itraconazole
formulations not interchangeable
130
Which triazole causes visual disturbances, hallucinations, skin cancer, and prolongs QTc?
voriconazole
131
Which triazole suspension requires food (ginger ale) for acidic environment?
posaconazole
132
Which triazole shortens QTc?
isavuconazole
133
Which triazole SHORTENS QTc?
isavuconazole
134
Which two triazole antifungals require a loading dose?
- voriconazole
| - isavuconazole
135
Antifungal TDM:
Voriconazole lower bound (ug/mL)?
1-1.5
136
Antifungal TDM:
Voriconazole upper bound (ug/mL)?
5-6
137
Antifungal TDM:
Posaconazole lower bound (ug/mL)?
> 0.5
138
Antifungal TDM:
Posaconazole upper bound (ug/mL)?
1.5
139
Antifungal TDM:
Itraconazole lower bound (ug/mL)?
> 0.5
140
Antifungal TDM:
Itraconazole upper bound (ug/mL)?
1-3
141
Antifungal TDM:
Flucytosine lower bound (ug/mL)?
30
142
Antifungal TDM:
Flucytosine upper bound (ug/mL)?
80
avoid >100
143
Oropharyngeal candidiasis (thrush) mild Tx?
daily x 7-10 days or miconazole mucoadhesive
144
Oropharyngeal candidiasis (thrush) moderate to severe Tx?
fluconazole 100mg-200mg daily x 7-14 days
fluconazole refractory use itraconazole or posaconazole
145
Recurrent esophagitis Tx?
fluconazole 100-200mg TIW
146
Esophageal candidiasis Tx?
fluconazole 200-400mg PO daily x 14-21 days
If NPO: fluconazole 400mg daily, micafungin 150mg IV daily, caspofungin 70mg LD then 50mg IV daily, anidulafungin 200mg IV daily
147
Empiric candidemia Tx?
echinocandin
148
Definitive candidemia Tx?
fluconazole 12mg/kg load, then 6mg/kg daily
voriconazole 6mg/kg BID x 2 doses then 3mg/kg BID
149
How long is candida endocarditis step down therapy?
>= 6 weeks after surgery
150
Candida endocarditis empiric Tx?
AmpB
for native valve: lipid Amp B
151
Intra-abdominal candidiasis empiric Tx?
micafungin 100mg, caspofungin 70mg, andiulafungin 200mg LD, then 100mg daily
152
Cryptococcal meningoencephalitis induction Tx?
AmpB liposomal 3-4mg/kg day + flucytosine 100mg/kg/day in 4 divided doses
153
Cryptococcal meningoencephalitis consolidation Tx?
fluconazole 6mg/kg/day x 8 weeks
154
pulmonary cryptococcosis for immunosuppressed pts Tx?
fluconazole 6mg/kg/day PO x 6-12 months
155
Pulmonary cryptococcosis for immunocompetent Tx?
fluconazole 400mg PO x 6-12 months
severe: treat like CNS disease
156
Pulmonary blastomycosis mod -severe Tx?
liposomal AmpB 3-5mg/kg/day x 1-2 weeks, then itraconazole 200mg PO TID x 3 days, then 200mg PO BID for 6-12 months
157
CNS blastomycosis Tx?
liposomal AmB 5mg/kg/day x 4-6 weeks, then oral triazole x 12 months or until resolution of CSF abnormalities
158
Coccidioidomycosis PNA Tx?
fluconazole >= 400g daily for 3-6 months
159
Mod-severe Histoplasmosis Tx?
lipid AmB 3-5mg/kg/day x 1-2 weeks, then itraconazole 200mg PO TID x 3 days, then BID x 12 weeks
160
Mild-Moderate acute histoplasmosis Tx?
itraconazole 200mg PO TID x 3 days, then BID x 6-12 weeks
161
Aspergillosis invasive pulmonary Tx?
voriconazole for 6-12 weeks
162
Which dimorphic mold is found in midwestern, east coast, and Great Lakes states?
blastomycoses
163
Which dimorphic mold is found in the Southwest and desert areas?
coccidioidomycosis
164
Which dimorphic mold is found in the Ohio and Mississippi River valleys?
histoplasmosis
165
Dimorphic molds:
What is mild-moderate coccidioidomycosis Tx?
observation and supportive therapy
166
Dimorphic molds:
What is severe coccidioidomycosis Tx?
fluconazole >= 400mg daily or itraconazole
167
Dimorphic molds:
What is mild-moderate blastomycosis Tx?
itraconazole 200mg 1-2 times/day
168
Dimorphic molds:
What is severe blastomycosis Tx?
liposomal AmB 3-5mg/kg/day x 2 weeks or until improvement, then itraconazole 200mg PO TID x 3 days, then 200mg PO BID
169
What is general Tx for C. albicans?
fluconazole
170
What is general Tx for C. glabrata?
echinocandin
171
What is general Tx for C. tropical?
fluconazole
172
What is general Tx for C. parapsilosis?
fluconazole
173
What is general Tx for C. krusei?
echinocandin
174
What is first line empiric Tx for mild oropharyngeal candidiasis?
clotrimazole or miconazole
175
What is first line empiric Tx for mod-severe oropharyngeal candidiasis?
fluconazole
176
What is alternative Tx for oropharyngeal candidiasis?
nystatin
177
What is first line empiric Tx for esophageal candidiasis?
fluconazole
178
What is alternative Tx for esophageal candidiasis?
echinocandin HD
179
What is first line empiric Tx for candidemia?
echinocandin
180
What are 2 alternative Tx for candidemia?
- fluconazole
| - voriconazole
181
What is first line empiric Tx for candida IEC?
AmpB +/- flucytosine, then fluconazole
182
What is first line empiric Tx for intra-abdominal candidiasis?
- source control
| - echinocandin
183
What are 2 alternative agents for intra-abdominal candidiasis?
- fluconazole
| - voriconazole
184
Do not use the NNRTI efavirenz if HIV viral load is what?
> 100,000 copies
185
VZV infectious period?
48 hrs before vesicle formation through 4-5 days after vesicles crust over
186
Measles infectious period?
4 days before to 4 days after rash onset
187
Kopek spots are associated with what condition?
measles
188
Subacute sclerosing pan encephalitis (SSPE) is a complication of what condition?
measles
can occur 7 years after infection
189
What Ro indicates the disease is spreading?
> 1
190
What is the Ro of measles?
18
191
Aseptic meningitis and encephalitis are associated with what disease?
mumps
192
Sleeping less than ___ hours/night is a risk factor for coronavirus
7
193
What % of the population should be vaccinated to stabilize Covid-19 spread?
60%
more than 60% to decrease the spread
194
What age is a risk factor for covid/
>=60
195
What is the Ro of Covid?
2.5
196
What is used to treat Amphotericin related rigors?
meperidine
197
What is main AE of flucytosine?
bone marrow suppression
198
ANC < __ is risk factor for invasive fungal infection.
500
neutropenia
199
Duration of candidemia treatment?
2 weeks from first negative culture
200
Dilated opthamalogical exam is done within 1 week of diagnosis of what fungal infection?
Candida caveats
201
What is an encapsulated yeast?
cryptococcus
202
Do echinocandins have in vivo activity?
no
203
With cryptococcal meningoencephalitis in HIV pts wait how long to start ARTs after initiation of antifungals to avoid risk of IRIS?
2-10 weeks
204
The dimorphic mold Blastomycoces clinical presentation is similar to what?
CAP or chronic PNA
205
Which dimorphic mold causes extreme fatigue?
cocciodiomycosis
incubation period 1-4 weeks
206
Solid organ transplant, hematopoietic stem cell transplant, prolonged neutropenia, and hematologic malignancy are risk factors for what mold?
Aspergillus
207
What test is specific to Aspergillosis?
galactomannan
CT halo sign specific to Aspergillosis:
halo sign
air crescent
nodules
208
Which mold is angio-invasive?
Mucormycosis
209
Reverse halo sign is specific to ___.
Mucormycosis
210
Mucor treatment?
Liposomal AmB 5-10mg/kg OR
| posaconazole 300mg daily
